PREFACE: Why this book was written
PROLOGUE:"A Different Perspective on Aging and Caring"
by Paul E. Ruskin, MDFOREWORD by Dan Osterweil, MD
Chapter 4: Absence Makes the Heart Grow Fonder... Long-Distance Care Giving
by Nancy Wexler, MA, MFCC
CHAPTER 1
My Story: Denial
("I've Walked a Mile in Their Shoes")
Bill...
CHAPTER 2
A Growing Profession
The services provided by private geriatric care managers and the reasons they are needed in society.
WhoWe Are
Our Raison D'Etre
People are living longer
We no longer have large extended families
More women are working than ever before
Kay....
It's not easy to care for a parent for so many years
Government services can be confusing
Government services are becoming scarce
The era of managed health care is here
We're Here to Help
Assessment
In-home assistance
Information and referrals
Placement services
Matching needs to services
Akira....
Matching facilities and budgets
Helping clients avoid the "black holes"
Surrogate family services
Helping businesses hold on to valued employees
Crisis intervention
Sarah....
Personal counseling
Caregiver Effectiveness Training (CET)
Forming a team - advocacy and ombudsman services
CHAPTER 3
The Scourge: Alzheimer's
Alzheimer's Disease is the fourth largest killer of adults in the United States. What's worse is the manner of death over a slow dragged-out period in which the victim loses memory and personality. The devastation to the family is equally profound. What Alzheimer's Disease is, what can be done for the victim and family and how a care manager brings much needed assistance to all is explained. A typical case history illustrates the trauma of the affliction and how a bad situation can be kept from destroying the family.
The Unrelenting Progress of Alzheimer 's
Statistics
The Alzheimer 's Road Map
Step #1: Complete Diagnostic Work-Up
Step #2: Educational, emotional, and medical support
Step #3: Financial and legal referrals
Step #4: In-home help
Step #5: Adult day-care
Step #6: Alternative living arrangements
Retirement hotels
Small board and care homes
Nursing homes
Memory Loss and Confusion
Doctors
Medications
An Alzheimer's Family
Mel....
Absence Makes the Heart Grow Fonder... Long-Distance Care Giving
We have become a nation where adult children and their parents frequently live thousands of miles apart. As a result, when elderly parents are in need of help from children, it is often impossible for the children to respond as they would were they living close by. The care manager can act as a surrogate child, serving the needs of both parent and adult child. Case histories demonstrate how the care manager can bring harmony out of discord.
Long-Distance Care Giving
Maria....
Otis....
Frances....
Emil....
CHAPTER 5
I've Got Those "Placement Blues"
When an older relative can no longer live independently, it is often up to the spouse, adult child or other relative to find the appropriate place for her/him to live. Many think that the nursing home is the only answer. Happily, it isn't. Retirement hotels, board and care homes and even staying "home" with appropriate in-home help are other options which are described. When, why, where and how to place are explored along with financing and tips to choose a quality residence for an elderly relative. Monitoring services and maintaining quality care are also discussed.
Determining When the Time Has Come
Questions to ask when an elderly family member lives alone
Safety need
Nutritional needs
Personal hygiene
Medical needs
Social needs
Placement Alternatives
Living with an adult child or relative
Health and safety
Time and energy
Family considerations
Emotional considerations
Situational considerations
Placement in a retirement hotel
Placement in a small board and care home
Social
Health
Economics
Family happiness
Placement in a life-care home
Placement in a nursing home
The atmosphere
The costs
The guilt
Choosing the right facility
CHAPTER 6
Success Stories: Case Histories of Successful Placements
Successful stories of placements in a nursing home, in a board and care home, at home, and in a retirement hotel.
Case Histories of Successful Placements
Molly....
David....
Manny, Moe & Jackie....
Anna....
Christopher....
CHAPTER 7
Mind Over Matter: Mental Diseases of the Elderly
Mental and emotional diseases strike older people at an alarming rate, ruining their quality of life and family relationships. Most don't know the signs and symptoms of disease, some of which appear to be physical illness. As a result, many treatable conditions are not dealt with, ruining what could otherwise be fruitful and productive final years for the elderly victim. Case histories demonstrate that much can be done to help an older person suffering from a neurosis or psychosis, as well as for the family.
Depression
Depression with a small "d"
Cicely....
Depression with a capital "D"
Rachael....
Psychotic Reaction to Dementia
Administering anti-psychotic medication
Selecting the right psychiatrist
Treatment in a psychiatric hospital
The treatment is not the cure
Day treatment programs
Schizophrenia
Bipolar Disease
Henry....
Some Final Thoughts
Pearl....
CHAPTER 8
Empowering Family Caregivers: God Helps Those Who Help Themselves
Not everyone can afford the services of a care manager, and so many must use one only sparingly. This chapter teaches those who wish to be their own geriatric care manager how to do the job for themselves. Tips on interviewing doctors, lawyers, in-home help, residential facilities and others who serve the elderly and their families are given, along with tips on following-up to make sure the work is done or service is performed correctly.
Handling the Case Yourself
Educate yourself
It's not easy
Jane....
Peter and Steve....
Where to begin?
Personal emergency response systems (PERS)
Home health care and in-home help
Serious problems
Community and employer-sponsored programs
Transportation
Volunteer services
If Your EFM Can No Longer Live at Home
Area Agencies on Aging
Senior centers
Doctors
Social service departments of hospitals
Clergy
Licensed referral agencies
Friends
Professional geriatric care managers
Nursing Home Placement
How do I choose a nursing home?
Paying for long-term care
The search
What if I have a disagreement with the nursing home?
Two Very Different Case Histories
Gladys....
Linda....
CHAPTER 9
Potpourri: Emotional and Financial Costs
Impact of eldercare on other family members (the ripple effect), who pays the tab, and what society needs to do to make life easier for seniors and their families.
The Ripple Effect
Health
Emotional well-being
Financial distress
Victoria....
Who Pays the Financial Tab?
Medicare
"Part A"
"Part B"
Medigap Insurance
Managed Health Care Plans
Nursing Home Insurance
Medicaid (Medi-Cal) and SS1
Where Else to Turn
Alzheimer 's Association
Alzheimer 's Disease Education and Referral Center
American Association of Retired Persons
Family Caregivers Alliance
National Academy of Elder Law Attorneys
National Association of Professional Geriatric Care Managers
National Council of Senior Citizens
Older Women's League
CHAPTER 10
Let's Play "Twenty Questions"
The most common questions concerning care for the elderly, not otherwise dealt with in the text, are asked and answered in detail.
I'm feeling overwhelmed and guilty: What should I do?
When should I start planning to care for my parents?
Liz....
I have mixed feelings about helping my parent:
How can I sort out love and responsibility?
How can I help my parent cope with widohood?
Should I encourage my EFM to talk about the past?
What can be done about insomnia?
Is it okay for my EFM to have a sex life?
How do I find a good geriatrician?
What are HMOs, POSs, PPOs, and IPA's?
Will Medicare pay for nursing home care?
Will Medicaid pay for nursing home care?
Should your EFM sell their house to qualify for Medicaid?
Can Medicaid put a lien on the house of a patient or spouse?
What is Parkinson's disease?
How do I handle problems caused by dementia?
What if my parents won't cooperate with the care they need?
What is a Conservatorship?
Is there any way to avoid Conservatoship?
Power of Attorney
Joint Tenancy
Who will make my EFM's health care decisions?
Durable Power of Attorney for Health Care
Living Will
Do Not Resuscitate Order
Should I promise I'll never put Mama in a nursing home
CHAPTER 11
Going for the Gold: A Framework for Assessing Quality of Life
Life should be more than merely existing. The factors that make up a quality life for the elderly are outlined with examples from real life used as illustrations.
The Definition of "Quality Living"
Biological integrity
Safety and security
Estate planning
Personal planning
Financial planning
Preserving rights
Belonging
Self-esteem
Self-actualization
Nomie....
Epilogue: Nomie Revisited
APPENDIX A: "Is Anybody Listening?"
APPENDIX B: The Tragic Progress of Dementia
Loss of short-term memory and impairment of judgment
Beginning dementia
Significant dementia
Severe dementia
The final stagesAPPENDIX C: Definition of Assisted Living and Philosophy of Care
APPENDIX D: Employers and Elder-Care in theWorkplace
APPENDIX E: Standards of Practice of the National Association of Professional Geriatric Care Managers
APPENDIX F: Additional Acknowledgments
APPENDIX G: Resources, Referrals, and Assistance
Products and catalogues
Bibliography
Glossary
Index
Notes
Quotes
Biographies of Authors
Home Back to main book page Copyright Nancy Wexler 1996, 1998.